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Hi everyone,

I have a clinical presentation the other day I'm not too sure on and would like some feedback please.

48 yo male initially presented in Jan for plantar heel pain in right which was resolved by gastoc stretching and ice massage. Gait at that time presented with slightly more pronation on the right. He has a history of AJ inversion sprains more so on his right managed by RICE by the patient.

He has now presented 3 months later with a sharp, shooting pain PMA distal to the MTPJ in his right.

Right Foot Symptoms: -pain after standing for more than 30 minutes
-pain after playing soccer for more than 30 minutes
-pain relieved by non-WB rest
-no oedema when in pain

Clinical Presentation: -Right clawing of the right digits
-Right FF is plantarflexed (pes cavus presentation although this was not seen in Jan)
-Right has weak peroneals (possibly due to AJ sprain), weak tib post, tib ant compared to left
- Sciatic pain in left side

Gait: - Right foot has a 'drop foot' and gait is consistent with compensation.

Any suggestions on Dx and Tx would be great.

Thanks. :hammer:

 

Magda:

With the limited clinical information you have provided, I would be thinking initially of some form of injury to the common peroneal nerve, a L5 radiculopathy or a progessive neurological disorder such as Charcot-Marie-Tooth Disease.

At this point, I suggest having the patient see a neurologist for a nerve conduction velocity/elecromyographic (NCV/EMG) study and consultation.